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[This corrects the article DOI: 10.1371/journal.pntd.0006797.].
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Systemic insecticides in dogs have been suggested as a public health intervention to prevent human cases of Zoonotic Visceral Leishmaniasis (ZVL). But, currently there are no systemic insecticides for dogs registered against zoo-anthropophilic pool blood feeding phlebotomine flies. We predict the impact of community-wide use of systemic insecticide in dog populations as a public health measure to control transmission of Leishmania infantum to humans using a mathematical model. We developed a Susceptible-Exposed-Infected (SEI) compartmental model to describe L. infantum transmission dynamics in dogs, with a vectorial capacity term to represent transmission between L. infantum-hosting dogs via phlebotomine flies. For Infected (I) dogs two levels of infectiousness were modelled, high infectiousness and low infectiousness. Human incidence was estimated through its relationship to infection in the dog population. We evaluated outcomes from a wide range of scenarios comprising different combinations of initial insecticide efficacy, duration of insecticide efficacy over time, and proportion of the dog population treated (60%, 70% & 80%). The same reduction in human infection incidence can be achieved via different combinations of insecticide efficacy, duration and dog coverage. For example, a systemic insecticide with an initial efficacy of 80% and 6 months above 65% efficacy would require treating at least 70% of the dogs to reduce the human infection incidence by 50%. Sensitivity analysis showed that the model outcome was most sensitive to baseline values of phlebotomine fly daily survival rate and insecticide coverage. Community-wide use of systemic insecticides applied to the "L. infantum canine reservoir" can significantly reduce human incidence of L. infantum infection. The results of this mathematical model can help defining the insecticide target product profile and how the insecticide should be applied to maximise effectiveness.
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Transmisión de Enfermedad Infecciosa/prevención & control , Enfermedades de los Perros/tratamiento farmacológico , Insecticidas/administración & dosificación , Leishmaniasis Visceral/veterinaria , Modelos Teóricos , Zoonosis/tratamiento farmacológico , Animales , Brasil , Enfermedades de los Perros/transmisión , Perros , Humanos , Incidencia , Leishmaniasis Visceral/tratamiento farmacológico , Leishmaniasis Visceral/prevención & control , Zoonosis/transmisiónRESUMEN
OBJECTIVES: Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. METHODS: This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs). RESULTS: Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. CONCLUSIONS: Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.
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Salud del Adolescente/estadística & datos numéricos , Hipoplasia del Esmalte Dental/epidemiología , Esmalte Dental/patología , Trastornos del Crecimiento/epidemiología , Incisivo/patología , Adolescente , Antropometría , Presión Sanguínea , Bolivia , Niño , Estudios de Cohortes , Femenino , Pruebas Hematológicas , Humanos , Indígenas Sudamericanos/estadística & datos numéricos , Masculino , MaxilarRESUMEN
OBJECTIVES: We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS: This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS: The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION: The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.
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Hipoplasia del Esmalte Dental , Desnutrición , Adolescente , Antropología Física , Bolivia/epidemiología , Niño , Preescolar , Hipoplasia del Esmalte Dental/epidemiología , Hipoplasia del Esmalte Dental/etiología , Hipoplasia del Esmalte Dental/patología , Dentición Permanente , Femenino , Trastornos del Crecimiento , Humanos , Indígenas Sudamericanos/estadística & datos numéricos , Lactante , Estudios Longitudinales , Masculino , Desnutrición/complicaciones , Desnutrición/epidemiología , Diente/patologíaRESUMEN
Background Urban centres in Vietnam have high rates of HIV infection, especially among men who have sex with men (MSM). A subgroup of MSM, young male sex workers (YMSW), are at especially high risk due to concurrent sex with multiple male and female partners, low levels of knowledge regarding HIV and sexually transmissible infection (STI) transmission, and limited engagement with health services, including STI and HIV screening and treatment. METHODS: A targeted intervention (SHEATH) derived from Harm Reduction and Sexual Health Promotion intervention technology was implemented in an out-of-treatment population of YMSW in Hanoi and Ho Chi Minh City (n=919). RESULTS: YMSW reported high levels of satisfaction with each of the seven core modules within the intervention and for the intervention as a whole. The intervention conferred significant benefit in relation to improved knowledge of STI and HIV transmission (P<0.001). Although only 36% of participants had seen a healthcare provider in the past year, following the intervention 81% intended to see one in the next 6 months. Similarly, although 71% of participants did not disclose that they were MSM the last time they visited a healthcare provider, following the intervention 71% intended to do so at their next visit. High rates of STIs (>10%) and HIV (9.5%) were also found. CONCLUSION: The data show that the SHEATH intervention can be implemented in this population and setting, is met with high rates of acceptability, and positively impacts STI and HIV knowledge and multiple health services outcomes (including knowledge of HIV status and disposition towards habituation of HIV screening).
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Infecciones por VIH/prevención & control , Homosexualidad Masculina , Trabajadores Sexuales , Conducta Sexual , Adolescente , Infecciones por VIH/transmisión , Humanos , Masculino , Parejas Sexuales , Enfermedades de Transmisión Sexual , Vietnam , Adulto JovenRESUMEN
OBJECTIVE: To develop and validate the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support, which estimates the risk of in-hospital death for neonates prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support. STUDY DESIGN: We used an international ECMO registry (2008-2013); neonates receiving ECMO for respiratory support were included. We divided the registry into a derivation sample and internal validation sample, by calendar date. We chose candidate variables a priori based on published evidence of association with mortality; variables independently associated with mortality in logistic regression were included in this parsimonious model of risk adjustment. We evaluated model discrimination with the area under the receiver operating characteristic curve (AUC), and we evaluated calibration with the Hosmer-Lemeshow goodness-of-fit test. RESULTS: During 2008-2013, 4592 neonates received ECMO respiratory support with mortality of 31%. The development dataset contained 3139 patients treated in 2008-2011. The Neo-RESCUERS measure had an AUC of 0.78 (95% CI 0.76-0.79). The validation cohort had an AUC = 0.77 (0.75-0.80). Patients in the lowest risk decile had an observed mortality of 7.0% and a predicted mortality of 4.4%, and those in the highest risk decile had an observed mortality of 65.6% and a predicted mortality of 67.5%. CONCLUSIONS: Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support offers severity-of-illness adjustment for neonatal patients with respiratory failure receiving ECMO. This score may be used to adjust patient survival to assess hospital-level performance in ECMO-based care.
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Oxigenación por Membrana Extracorpórea/mortalidad , Mortalidad Hospitalaria , Medición de Riesgo , Peso al Nacer , Femenino , Edad Gestacional , Hernias Diafragmáticas Congénitas/mortalidad , Hernias Diafragmáticas Congénitas/terapia , Humanos , Concentración de Iones de Hidrógeno , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/terapia , Recién Nacido , Modelos Logísticos , Masculino , Síndrome de Aspiración de Meconio/terapia , Curva ROC , Sistema de Registros , Insuficiencia Renal/mortalidad , Síndrome de Dificultad Respiratoria del Recién Nacido/mortalidad , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/terapia , Sepsis/mortalidad , Sepsis/terapia , Índice de Severidad de la Enfermedad , Factores SexualesRESUMEN
UNLABELLED: Background This paper examines sexual practices, partner concurrency and sexually transmissible infections (STI)/HIV infection among male sex workers (MSWs) in Vietnam. METHODS: Six hundred and fifty-four MSWs, aged 16-35 years, were recruited in Hanoi, Nha Trang and Ho Chi Minh City between 2009 and 2011. Survey measures included demographic characteristics, drug use, types of sexual partners and sexual practices. Subjects were screened for STIs, including HIV. RESULTS: MSWs in Ho Chi Minh City (33%) were more likely than those from the other two sites to be current users of one or more types of illegal drugs (P<0.001). MSWs with both male and female elective partners (compared with other partnership types) were more likely to have anal sex with male client partners (P<0.001), elective male partners (P=0.045) and elective female partners (P=0.025). At last sex with a male client partner, only 30% used a condom during anal intercourse. At last sex with an elective female partner, only 31% used a condom during vaginal sex and only 3% during anal sex. Although rates of HIV are low (4%), other STIs are high, including chlamydia (17%), gonorrhoea (29%) and human papillomavirus (33%). Most (57.3%) have never been tested for HIV and only 17% have ever disclosed to a healthcare provider that they have sex with men. CONCLUSIONS: Complex patterns of sexual concurrency, coupled with high rates of STIs, signal the urgent need for health services interventions among MSWs, both to improve individual health outcomes and to reduce secondary STI/HIV transmission among sexual partner networks.
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INTRODUCTION: Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. AIM: In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. METHODS: Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. MAIN OUTCOME MEASURES: We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. RESULTS: Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027). CONCLUSIONS: These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.
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Circuncisión Masculina , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Hispánicos o Latinos , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/transmisión , Sexo Inseguro , Adulto , Encuestas Epidemiológicas , Humanos , Masculino , Puerto RicoRESUMEN
OBJECTIVE: Puerto Rico has high HIV prevalence and incidence rates, including a large prison population living with HIV. While HIV treatment is available within the prisons, there are no linkages to care or treatment preparedness interventions following release. METHODS: In an effort to assess the risk of treatment discontinuity in this group, we examined data from an ongoing epidemiological study in the largest, publicly funded HIV/sexually transmitted infection (STI) treatment center in the San Juan area. RESULTS: Among the newly enrolled, HIV-positive patients with a history of incarceration, there was an average 4-year gap in reengagement in treatment. Drug and sexual risk behaviors were prevalent, as was evidence of significant immune impairment (including high viral load and low CD4 count). CONCLUSIONS: Treatment discontinuity may contribute to poor health outcomes in this group and also fuel new infections. There is an urgent need for interventions to retain HIV-positive inmates in community HIV care following release.
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Infecciones por VIH , Enfermedades de Transmisión Sexual , Infecciones por VIH/epidemiología , Humanos , Puerto Rico , Asunción de Riesgos , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices.
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Infecciones por VIH/prevención & control , Reducción del Daño , Dependencia de Heroína/complicaciones , Heroína/administración & dosificación , Abuso de Sustancias por Vía Intravenosa/complicaciones , Administración por Inhalación , Adolescente , Adulto , Edad de Inicio , Estudios Transversales , Progresión de la Enfermedad , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Heroína/efectos adversos , Dependencia de Heroína/epidemiología , Humanos , Inyecciones Intravenosas , Masculino , Fumar/efectos adversos , Fumar/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Factores de Tiempo , Vietnam/epidemiología , Adulto JovenRESUMEN
Sistemas digitais sofisticados de fotografia em três dimensões melhoraram muito a captura de imagens do corpo humano. A introdução de um sistema rápido, não-invasivo e sem radiação ionizante, e esses avanços possibilitam novas aplicações da imagem em três dimensões na cirurgia plástica. Desde 2004, o Royal Children's Hospital (RCH) de Melbourne utiliza o sistema de fotografia digital em três dimensões 3dMD, que foi montado num centro exclusivamente dedicado (Centro de imagens da Batten Foundation). Desde então, uma equipe multidisciplinar trabalha para desenvolver técnicas mais apuradas para coletar e analisar informações para que se possa titrar pleno proveito dessa poderosa tecnologia. Este artigo descreve uma série de aplicações clínicas onde a captura de dados em três dimensões e sua análise têm sido úteis.
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Humanos , Diagnóstico por Imagen , Imagenología Tridimensional , Fotograbar , Cirugía Plástica , Procesamiento de Imagen Asistido por Computador , Técnicas y Procedimientos DiagnósticosRESUMEN
The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.
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Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Heroína/administración & dosificación , Homosexualidad Masculina/estadística & datos numéricos , Narcóticos/administración & dosificación , Trabajo Sexual/estadística & datos numéricos , Adolescente , Adulto , Estimulantes del Sistema Nervioso Central/administración & dosificación , Infecciones por VIH/transmisión , Alucinógenos/administración & dosificación , Humanos , Masculino , Factores de Riesgo , Asunción de Riesgos , Encuestas y Cuestionarios , Sexo Inseguro/prevención & control , Sexo Inseguro/psicología , Vietnam/epidemiologíaRESUMEN
A continuous surveillance programme for the presence of the red howler monkeys (Alouatta sp.) in the forests of Trinidad was initiated following an epizootic of yellow fever in these monkeys in 1978. This paper gives the result of the programme from 1986 to 1989.
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Alouatta , Cebidae , Fiebre Amarilla , Trinidad y TobagoRESUMEN
Of a total of 18,068 mosquitoes (361 pools) collected in south-eastern Trinidad forests from December, 1988 to May, 1989, 47 species belonging to 14 genera were identified. Five yellow fever virus isolates were made from Haemagogus janthinomys and one from Sabethes chloropterus. All the other pools of mosquitoes examined were negative for the virus. The mosquito isolates were made in December and January. In addition, in late February and early March, two infected howler monkeys (Alouatta sp.) were detected. Since March, despite continued surveillance, no yellow fever virus has been detected in mosquitoes or monkeys. There has been no reported human infection.
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Fiebre Amarilla , Trinidad y TobagoRESUMEN
Of a total of 18,068 mosquitoes (361 pools) collected in south-eastern Trinidad forests from December, 1988 to May, 1989, 47 species belonging to 14 genera were identified. Five yellow fever virus isolates were made from Haemagogus janthinomys and one from Sabethes chloropterus. All the other pools of mosquitoes examined were negative for the virus. The mosquito isolates were made in December and January. In addition, in late February and early March, two infected howler monkeys (Alouatta sp.) were detected. Since March, despite continued surveillance, no yellow fever virus has been detected in mosquitoes or monkeys. There has been no reported human infection (AU)
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Fiebre Amarilla , Trinidad y TobagoRESUMEN
A continuous surveillance programme for the presence of the red howler monkeys (Alouatta sp.) in the forests of Trinidad was initiated following an epizootic of yellow fever in these monkeys in 1978. This paper gives the result of the programme from 1986 to 1989 (AU)
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Cebidae , Monitoreo Epidemiológico , Alouatta , Fiebre Amarilla , Trinidad y TobagoRESUMEN
Of a total of 18,068 mosquitoes (361 pools) collected in south-eastern Trinidad forests from December 1988 to May 1989, 47 species belonging to 14 genera were identified. Five yellow fever virus isolates were made from Haemagogus janthinomys and one from Sabethes chloropterus. All the other pools of mosquitoes examined were negative for the virus. The mosquito isolates were made in December and January. In addition, in late February and early March, 2 infected howler monkeys (Alouatta sp.) were detected. Since March, despite continued surveillance, no yellow fever virus has been detected in mosquitoes or monkeys. There has been no reported human imfection. (AU)